Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Paramount Farms Inc. of Lost Hills, Calif., announced a recall of 8 million pounds of almonds Friday after 5 million pounds were recalled on Tuesday on the basis of reports from the FDA that seven people in Alaska, Arizona, Oregon, Washington and Utah had taken ill with salmonella enteritidis, a type of food poisoning. Almonds in five cases had been bought from Costco Wholesale Corp. in Oregon, Paramount Farms said.

In a statement issued Friday, the company said the FDA expanded the recall after learning of an additional illness in Michigan from three months ago. The FDA said it is aware of 18 cases of salmonella enteritidis possibly related to the recalled almonds.

“We are contacting our distributors to determine if the additional product that the FDA suggests recalling is of concern,” Paramount Farms said.

The expanded recall covers almonds distributed by Paramount Farms with a “best before” date of 8/21/04 or later.

“FDA has learned that Paramount Farms distributed the recalled almonds in bulk or packaged nationwide to brokers, distributors and grocery store chains which in turn sold the almonds to consumers in a variety of package sizes with a variety of brand names,” the agency said Friday.

The company said it has instituted additional safety and quality assurance procedures since the original recall.

Young children, the elderly and people with weakened immune systems are especially vulnerable to infection from salmonella. It can be fatal.

People who experience symptoms consistent with salmonella poisoning after eating almonds, including fever, diarrhea, nausea, vomiting and abdominal pain, should consult their doctors or local health departments.

Consumers who have the recalled almonds are asked to return them to the stores where they bought them. People with questions about the recall can reach Paramount Farms at 1-800-496-5168.